Social Public Policies for Cardiovascular Health among U.S. Adults: A Systematic Review

Cardiovascular diseases (CVDs) are the most common chronic diseases and leading causes of death among United States (U.S.) adults. Social public policies in the U.S. (including public assistance programs) have the potential to address the social determinants of CVDs and may indirectly contribute to a decline in cardiovascular morbidity and mortality. This review sought to examine associations between social public policies and CVDs among U.S. adults.

Using PubMed, Web of Science, and Embase, a systematic search of full-text articles published between January, 1990 and July, 2024 that examined the effect of public policies on CVDs among adults in the U.S. or in U.S. territories was conducted between September and October, 2024. Study characteristics and statistical results were presented.

Out of 11,585 potentially eligible records identified, 46 reports (studies) were included in this review after sequential title, abstract, and full-text screening. Four public policy groups emerged: smoking-related legislation (n=32), housing assistance (n=7), food assistance (i.e. Supplemental Nutrition Assistance Program) (SNAP) (n=6), and air pollution regulation (n=1). The most commonly-examined outcomes were acute myocardial infarction, cardiovascular-related mortality, and hypertension. Smoking-related legislation was associated with decreased incidence and prevalence of CVDs. Findings were mixed regarding the associations of housing assistance and SNAP with CVDs, while air pollution regulation was not associated with CVDs.

Overall, smoking-related legislation was protective against CVDs, while the patterns of findings about the other policy types and CVDs were less conclusive. Inferences about causality were limited given observational and/or cross-sectional study designs, particularly for studies examining housing assistance or food assistance. Regarding the effect of public policies on CVDs, future studies should examine the role of specific policy characteristics and further explore sociodemographic disparities.